Children may survive severe myocarditis with prolonged use of biventricular assist devices

The outcome of acute myocarditis with cardiogenic shock is poor. In some ch ildren in whom aggressive medical treatment fails, artificial replacement o f heart function may offer lifesaving support until the myocardium has reco vered. Four previously healthy children (three boys aged 4, 6, and 1 years; one girl aged 5) developed acute myocarditis with ventricular failure and multiorgan dysfunction caused by low cardiac output. Biventricular assist d evices (BVAD) were implanted for prolonged support. In three children cardi ac function improved and after up to 21 days mechanical support could be wi thdrawn. They had full recovery of heart function. In the fourth patient th ere was no myocardial recovery after a period of 20 days. He underwent orth otopic heart transplantation with an uneventful postoperative course. Prolo nged circulatory support with BVAD is an effective method for bridging unti l cardiac recovery or transplantation in children.